Biden reverses Trump's damaging family planning restrictions

On Nov. 8, Trump-era restrictions on funding under the Title X family planning program will be no more: Earlier this week, the Biden administration formally announced a final regulation that will undo the Trump administration’s 2019 rule that radically overhauled and seriously limited the program.

At root, the 2019 rule blocked family planning clinics that also perform abortions from receiving any Title X money, even though clinics were already barred from using Title X money for abortion services. 

Other restrictions included eliminating “nondirective” pregnancy counseling offering people information about the full range of pregnancy options, including abortion. That meant that clinics that received money under Title X could refuse to provide an abortion referral or could provide what the Guttmacher Institute, an organization that studies reproductive health laws,  described as a “misleading list of comprehensive primary care sites” that may or may not include abortion providers and that might not note which of those sites offered abortions.  

Additionally, the rule imposed requirements about the physical and financial separation between abortion and other Title X-funded services. 

These restrictions were so onerous that Planned Parenthood had to withdraw from the Title X program entirely. Planned Parenthood served roughly 40% of all Title X patients, individuals who have lower incomes, are uninsured, or are otherwise unable to obtain cost-effective family planning options and information. 

Immediately after taking office, President Joe Biden directed the Health and Human Services Department to review the 2019 Title X rule and consider whether to revise or rescind it. The department undertook a comprehensive review of the Trump administration’s justifications for the rule change and of the effects the rule change had. 

One of the major reasons the Trump administration gave for restricting Title X funds was that grantees receiving funding for family planning services were also impermissibly using it for abortions. The review by HHS found that there were only “minor compliance issues” with grantees, and those issues were only found in two General Accounting Office reports dating from the 1980s. And, while those reports noted some confusion on the part of grantees, GAO found no evidence at all that Title X funds had ever been used for abortions or even to advise people about having an abortion. 

HHS also explored the impact of the 2019 rule on how many people were served under Title X after the rule was passed, and there was a drastic drop in the number. HHS noted that hundreds of service sites had to immediately withdraw from the Title X program in the wake of the rule because they would not be able to comply with the new restrictions. The program served 844,083 fewer people in 2019 than in the previous year, a 22% decrease. The number in 2020 was even lower, with a drop of over 1.5 million people served versus 2019. All told, from 2018 to 2020, 60% fewer patients obtained services under Title X.

The impact was also geographic. After programs were forced to withdraw, six states were left with no Title X services, and an additional seven were only able to offer Title X services on a “very limited basis.”

Finally, HHS also found that providers who did accept the restrictions and stayed in the program ended up diverting Title X funds away from family planning. Instead, those funds went to the greater costs that resulted from the physical and financial separation requirement and what HHS called “the micro-level monitoring and reporting now required of grantees.”

Where the Trump administration relied upon assertions about noncompliance that weren’t backed up by data in imposing its rule, the Biden administration’s move is grounded in data. 

Now, health care organizations like Planned Parenthood are able to return to providing family planning services to low-income individuals. There is still a significant limitation in the new rule, however. As Alexis McGill Johnson, president and CEO of Planned Parenthood Federation, of America pointed out, the Biden rule will still “allow providers to refuse to counsel or refer patients for abortions due to their own personal beliefs.” That said, Johnson noted the rule change is a “major victory for patients, access to sexual and reproductive health care, and health equity.” 

The health equity component is important. In 2017, prior to the Trump rule, 21% of the patients in the Title X program were Black, and an additional 33% were Hispanic or Latino. Title X providers also serve rural communities where little or no other family planning resources are available. Restoring robust Title X funding to Planned Parenthood and other clinics will help close these gaps. 

Published with permission of The American Independent Foundation.